Tomorrow's Medicine

Medical advances and earlier detection play a key role in fighting prostate cancer.

Medical advances and earlier detection play a key role in fighting prostate cancer.
One in every six men eventually develops prostate cancer, but the slow-moving illness is increasingly detected and treated before it becomes deadly. And with promising medical advances in both radiation and surgery -- the two most common forms of treatment -- patients are recovering from it more quickly than ever.

A new procedure called helical tomotherapy uses 3-D intensity modulated radiation therapy, or IMRT, to deliver higher doses of radiation to the cancerous area without exposing the patient to as much toxicity as other methods. In surgery, the latest technique is a non-invasive procedure called robotic laparoscopic radical prostatectomy, which uses robotic equipment to remove the prostate through four or five tiny incisions in or around the belly button.

Both options cut down on stress to the body, allowing the patient to get back to normal after two months of radiation or within 48 hours of surgery. But these procedures are so new that they don't appear in most medical literature, and men must travel to get them at specialized treatment facilities nationwide. The M.D. Anderson Cancer Center in Orlando, which offers both, draws patients from as far away as California, Hawaii and Alaska.

About 232,090 U.S. men will learn they have prostate cancer this year, including 19,650 in Florida, according to the American Cancer Society. The prostate is the most common location of cancer among men, accounting for 33% of new cases this year. It's the second most deadly and will cause 10% of cancer deaths among men this year, compared with 31% attributed to lung cancer.

Once prostate cancer is detected, patients face a tough decision. "The earlier the stage of the cancer, the more it gets confusing because there are more of these options that will work," says Dr. Patrick Kupelian, director of research in the Department of Radiation Oncology at M.D. Anderson in Orlando.

ADVANCES: Dr. Patrick Kupelian of the M.D. Anderson Cancer Center in Orlando works with a helical tomotherapy machine that delivers prostate cancer treatment.

Treatments
Helical tomotherapy

In this new type of image-guided intensity modulated radiation therapy, the patient undergoes a daily CT scan to help doctors create a 3-D image that pinpoints the precise area of cancer. Radiation doses are administered in a spiral delivery pattern, with the cancerous cells receiving the highest concentration. Patients receive treatment five days a week for about two months.
For more information, visit www.tomotherapy.com.

Robotic laparoscopic radical prostatectomy

Surgeons insert a tiny lighted camera through four to five small incisions in the patient's stomach, sometimes through the belly button. Doctors can remove the prostate entirely without subjecting the patient to blood loss and a long recovery period. Patients usually leave the hospital in one or two days.

Radiation can be used with many stages of prostate cancer. This can be performed through external radiation beams, implanted radioactive metal seeds or a combination of both.

Hormonal treatment

The treatment is designed to eliminate testosterone, which can slow the growth of prostate cancer cells or cause them to go dormant. This can be done through surgical removal of the testicles or injection or ingestion of drugs. It's usually recommended for men who have major illnesses that might prevent them from considering other options.

Chemotherapy

Medicines are used to kill off fast-growing cancer cells. This treatment causes multiple side effects. It's usually reserved for late-stage cases that aren't responding to other treatments.

Watchful waiting

Periodic testing makes sure there's no major change in cancer levels. This is recommended for patients who are very elderly or suffering from something that's expected to end their lives before the prostate cancer.
Sources: M.D. Anderson Cancer Center in Orlando, www.mdandersonorlando.org, and the Prostate Cancer Foundation, www.prostatecancerfoundation.org